Caring for patient with Alzheimer

1. Caring for patient with Alzheimer Hanan shteiwi Amal al-zyoud

2. Outline : • Objectives • Introduction • Definition • Causes & Risks • S&S • Diagnostic evaluation , treatment , prevention • Nursing care plan (diagnosis , goals , interventions ) • Conclusion and summary • References

3. Objectives : At the end of this seminar the student will be able to : ¤ Identify alzheimer disease definition . ¤ Identify causes , risks , stages , prevention. ¤ Identify clinical manifestation . ¤ Formulate nursing care plane for patient with Alzheimer disease .

4. Introduction : ¤ Worldwide, nearly 44 million people have Alzheimer’s or a related dementia . ¤ Alzheimer’s and other dementias are the top cause for disabilities in later life . ¤ Alzheimer's disease is the sixth-leading cause of death across all ages in the United States. For those 65 and older, it is the fifth-leading cause of death . ¤ Alzheimer is not a normal part of aging & younger people can be affected . ¤ Currently There is no cure for Alzheimer disease . ¤ In Jordan there are currently 16,500 people with clinically significant Alzheimer's disease .

5. Definition : Alzheimer’s : is a neurologic disease of the brain that result from irreversible degeneration of the brain ( cerebral cortex ) , which causes problems with memory, thinking and behavior. It is not a normal part of aging and gets worse over time.

7. Causes and risks : ¤ The cause of Alzheimer’s disease is unknown. ¤ There are several factors effect it’s progression : 1. genetics . 2. Neurotransmitter changes(Serotonin,dopamine) 3. Vascular abnormalities . 4. Stress hormones . 5. Age . 6. Down syndrome . 7. Head injury . 8. Gender .

8. Down syndrome and Alzheimer’s disease It is noted that the pathological changes of DS at middle age (i.e. the form and distribution of senile plaques and neurofibrillary tangles, the pattern of involvement (atrophy) of neuronal systems) are qualitatively the same as those of AD at that age, though quantitative differences do occur and these may relate to biological or sociological variations inherent to the two parent populations.

9. Stages : • Early stages : people may experience behavioral and personal changes such : Feeling as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects. ( Irritability, Anxiety, Depression, Memory loss, confusion ) • Late stages : bedridden , unable to perform ADL , incontinence , Motor disturbance

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11. BDNF : It appears that higher blood levels of brain-derived neurotrophic factor (central nervous system, especially in the cerebral cortex and in the brain’s memory seat) may be able to protect people against development of Alzheimer’s disease and other types of dementia, according to a study published online in JAMA Neurology . BDNF levels in the top quintile were associated with less than half the risk for Alzheimer’s or dementia

12. Signs & Symptoms : MEMORY IMPARMENT : ⊙ Increasing forgetting ⊙ Confusion ⊙ Uanusual difficulty remembering things ⊙ Repeat statements and questions, not realizing that they've asked the question before ⊙ Forget conversations, appointments or events ⊙ Get lost in familiar places ⊙ Eventually forget the names of family members

13. Signs & Symptoms : LANGUAGE DIFFICULTIES: ¤ Anomia, the inability to find the right word ¤ Aphasia develops, and the person is unable to understand what he hears. ¤ Poor Judgment PERSONALITY CHANGES: ¤ Loss of interest in previously enjoyed activities ¤ Paranoia ¤ Delusional thinking

15. Signs & Symptoms : BEHAVIORAL PROBLEMS: ¤ Suspicion of others , Stealing ¤ Hiding things ¤ Repeating questions or statements ¤ Performing compulsive activities ¤ Wandering & violence

16. Also .. People with Alzheimer's may experience: - Depression . - Apathy (carelessness) . - Social withdrawal . - Mood swings . - Irritability and aggressiveness .

17. DIAGNOSIS : STEPS TO DIAGNOSIS INCLUDE: 1. Understanding the problem : » What kind of symptoms have occurred. » When they began. » How often they happen. » If they have gotten worse.

18. DIAGNOSIS : 2.Reviewing medical history : The doctor will interview the person being tested and others close to him or her to gather information about current and past mental and physical illnesses. It is helpful to bring a list of all the medications the person is taking.

19. DIAGNOSIS : 3.Evaluating mood and mental status : » Is aware of symptoms ? » Knows the date, time and where he or she is (oriented) ? » Can remember a short list of words, follow instructions and do simple calculations ?

20. DIAGNOSIS : 4.Physical exam and diagnostic tests : » Evaluate diet and nutrition. » Check blood pressure, temperature and pulse. » Listen to the heart and lungs. » Perform other procedures to assess overall health.

21. DIAGNOSIS : 5.Neurological exam : » Reflexes . » Coordination . » Muscle tone and strength . » Eye movement . » Speech . » Sensation . » Brain imaging study, the most common is (MRI) or (CT) .

22. Role of community health nurse : ⊙ Cognitive enhancement . ⊙ Communication with family, caregivers . ⊙ Environmental modification . ⊙ safe and supportive environment . ⊙ Exercise and mobility . ⊙ Nutrition .

23. Medical treatment : • Acetylcholine – cholinesterase inhibitor – (memory & learning) /Such : exelon • Glutamate antagonist / such : Namenda (regulation of cognitive function) • Supplements : Vit.E , calcium ,Vit.b12

24. Prevention: 1. REGULAR EXERCISE : ( benefit by the increased blood and oxygen flow ) 2. MENTAL ACTIVITIES AND SOCIAL : Connection is unknown, but it is believed to be due to direct mechanisms in which connections between nerve cells in the brain are strengthened . Such as : Reading and writing every day. Play games (e.g., chess, cards).

25. Nursing Diagnosis : • Bathing or hygiene self-care deficit • Disabled family coping • Disturbed thought processes • Dressing or grooming self-care deficit • Feeding self-care deficit • Imbalanced nutrition: Less than body requirements • Impaired verbal communication • Ineffective coping Interrupted • Risk for infection • Risk for injury • Toileting self-care deficit

26. Goals : • Patient will have appropriate maintenance of mental and psychological function as long as possible, and reversal of behaviors when possible. • Patients will have behavioral problems identified and controlled. • remain free from signs and symptoms of infection • (Family members will) identify strategies to make the patient's environment as safe as possible perform • toileting needs within the confines of the disease process

27. Intervention : ¤ Encourage the patient to exercise as ordered to help maintain mobility. ¤ Assist the patient with hygiene and dressing as necessary ¤ Simplify daily activities into short achievable steps so that patient feels a sense of accomplishment ¤ Protect patient from injury ,Provide a safe, structured environment (Remove objects that could cause injury) ¤ Provide a calm, predictable environment to minimize confusion and disorientation.

28. Intervention : ¤ Provide rest periods between activities because these patients tire easily . ¤ Provide emotional support to the patient and his family Encourage them to talk about their concerns Listen carefully to them Answer their questions honestly . ¤ take the patient to the bathroom at least every 2 hours Make sure he knows the location of the bathroom . ¤ Help patient feel a sense of security with a quiet, pleasant manner; clear, simple explanations; and use of memory aids and cues . • Administer ordered medications to the patient and note their effects with depressive symptoms should be considered for antidepressant

29. Intervention : ¤ Give the patient semisolid foods if he has dysphagia ¤ Refer family to the Alzheimer’s Association for assistance with family support groups, respite care, and adult day care services ¤ Monitor the patient’s fluid and food intake to detect imbalances. ¤ Encourage sufficient fluid intake and adequate nutrition

30. Conclusion : ¤ Alzeheimer disease is a worldwide disease that can effect any person . ¤ We can decrease the risk of Alzeheimer disease by following the preventing methods ¤ {وَاللَّهُ خَلَقَكُمْ ثُمَّ يَتَوَفَّاكُمْ وَمِنْكُمْ مَنْ يُرَدُّ إِلَى أَرْذَلِ الْعُمُرِ لِكَيْ لَا يَعْلَمَ بَعْدَ عِلْمٍ شَيْئًا إِنَّ اللَّهَ عَلِيمٌ قَدِيرٌ }سورة النحل - 70

31. Summary : ⊙ Is a chronic, irreversible disease that affects the cells of the brain and causes impairment of intellectual functioning.  ⊙ And shows at age 60 and over ⊙ It’s resulting in memory impairment , language difficulties , behavioral problems & personality changes ⊙ Diagnostic test include MRI , CT , lab test ,physical and psychological exams

32. References : ⊙ Alzheimer’s Disease International’s World Report ⊙ Mayoclinic.com ⊙ WebMD.com ⊙ Alzheimer assosciation.com ⊙British society of gerontology ⊙ National Institutes of Health